Treatment of Diabetes – Oral Agents Flashcards
Intensive glucose control has been shown to reduce _________________.
microvascular disorders and all-cause mortality
Recombinant human insulin was first approved by the FDA in ________.
1982
What diabetes drug is an alpha glucosidase inhibitor?
Acarbose
For type 2 diabetes, the first therapy recommended –and the cornerstone of all therapies –is _________.
lifestyle modifications (weight loss; lower calorie intake; more complex carbohydrates)
True or false: biguanide increases the release of insulin.
False. Biguanide (brand name Metformin) enhances insulin’s ability to suppress hepatic glucose release.
Recently, guidelines have recommended that doctors assess ________ before prescribing Metformin to patients.
GFR
What are the pros and cons of Metformin use?
Pros:
- it doesn’t cause weight gain
- it can be used with other diabetes medications
- it doesn’t carry a risk of hypoglycemia
- it is inexpensive
Cons:
- it can cause GI side effects
- it carries a risk of lactic acidosis (particularly with concomitant imaging contrast, CHF, renal insufficiency, or liver disease)
After trying lifestyle modifications, give _________ to those with T2DM.
Metformin
Which two oral medications can lower A1c by the maximum amount?
Metformin and the sulfonylureas (both of which can lower A1c by 1-2%
GLP-1 is made by the _______________.
L cells in the distal ileum
GIP (gastric inhibitory peptide) is made by ____________.
the K cells in the duodenum
GLP-1 and GIP are secreted in response to ____________.
food intake
What is the incretin effect?
Consuming food by mouth leads to a greater release of endogenous insulin than does raising blood glucose levels to the same amount.
Those with __________ have a decreased incretin effect.
T2DM
In addition to stimulating insulin release, the incretins also ____________.
decrease glucagon release
GLP-1 decreases hepatic release of glucose via two mechanisms: ______________.
decreasing release of glucagon and increasing release of insulin (which also decreases gluconeogenesis by the liver)
True or false: the GLP-1 analogues can be given orally.
False. The DPP-4 inhibitors, however, are oral.
What does SGLT-2 stand for?
Sodium-GLucose co-Transporter 2
The -gliflozin drugs work by what mechanism?
They inhibit the SGLT-2 channels, thereby preventing glucose reuptake in the proximal convoluted tubules of the kidney.
The maximum glucose concentration at which SGLT-2 can re-absorb in the PCT is __________; the -gliflozins bring this down to __________.
180 mg/dL; 90 mg/dL
What side effects do the SGLT-2 inhibitors drugs cause?
- Increased risk for UTIs (from the excess urinary glucose)
- Risk for hypokalemia (be sure to correct this in the PDF/PP, because she said she accidentally wrote hyperkalemia)
- Hypotension (because of osmotic diuresis)
What side effects come with use of sulfonylureas?
- Hypoglycemia
- Weight gain
- Loss of effectiveness due to increased insulin resistance
Which two non-insulin drugs should you NEVER co-administer?
GLP-1 analogues and DPP-4 inhibitors
Which three non-insulin drugs are best for patients with ASCVD?
Metformin
GLP-1 agonists
SGLT-2 inhibitors
Go straight to insulin in type 2 diabetics with _____________.
impaired renal or hepatic function
The shortest-acting sulfonylurea is ___________.
glipizide
What are three contraindications for sulfonylurea?
Liver disease, renal failure, or G6PD deficiency
The FDA now recommends obtaining ___________ prior to prescribing metformin.
the patient’s eGFR
Use of ___________ has been associated with bladder cancer.
thiazolidinediones
True or false: GLP-1 secretion by L cells in the distal ileum occurs roughly an hour after food has been ingested.
False. It occurs within minutes.
Why is there no pharmacologic analogue of GIP?
Because those with type 2 diabetes are generally resistant to the effects of GIP
The two main effects of using GLP-1 analogues are ____________.
lowered A1c and weight loss
What is the main advantage of DPP-4 use over GLP-1 analogue use?
DPP-4 are oral!
Pramlintide was developed because amylin ______________.
has a tendency to form amyloid deposits
The main effects of pramlintide are _______________-.
delayed gastric emptying and decreased postprandial glucagon secretion
You know that metformin and GLP-1RAs can help with weight loss, but there is another non-insulin diabetes medication that can, too. What is it?
SGLT-2
The least potent drug (in terms of A1c lowering ability) is ____________.
DPP-4 inhibitors
what two drugs lower cardiovascular events
SGLT2 inhibitors and GLp-1 agonists
indications for SGLT2
reduce CV risks
prevent heart failure hospitalization
reduce BP
oral administration
Indications for GLP-1 agonist
reduce CV risk
weight loss
once weekly subcutaneous dosing
